April 21, 2026Journal of the American College of Cardiology282 citations
View Full PaperTrends and Outcomes of Restenosis After Coronary Stent Implantation in the United States
Key Result
PCI for in-stent restenosis accounted for 10.6% of all PCIs and showed no significant differences in in-hospital complications or length of stay compared to non-ISR PCI.
Key Points
- This study analyzes the trends, presentation, treatment, and in-hospital outcomes of in-stent restenosis (ISR) following PCI.
- Retrospective analysis of data from the CathPCI registry (2009-2017)
- Identified patients undergoing PCI specifically for ISR lesions
- Utilized propensity-score matching for outcome comparisons
- 10.6% of 5,100,394 PCI procedures were for ISR lesions
- Bare-metal stent ISR decreased from 2.6% to 0.9% (p < 0.001) while drug-eluting stent ISR increased from 5.4% to 6.3% (p < 0.001)
- No significant differences in in-hospital complications or length of stay between ISR and non-ISR PCI patients
Study Design
Type
Observational (n=5,100,394)
Multicenter
Yes
Structured PICO
Does PCI for in-stent restenosis have different in-hospital outcomes compared to PCI for non-ISR lesions?
P
Population
5,100,394 patients undergoing percutaneous coronary intervention (PCI) in the United States between 2009 and 2017 (CathPCI registry of the NCDR).
I
Intervention
Percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) lesions.
C
Comparator
Percutaneous coronary intervention (PCI) for non-ISR lesions (propensity-score matched for in-hospital outcomes comparison).
O
Outcome
In-hospital complications and hospital length of stay.
In-stent restenosis accounts for approximately 10.6% of all PCIs in the US, and despite presenting less frequently with acute myocardial infarction, in-hospital outcomes are comparable to non-ISR PCI.
Abstract
BACKGROUND There is a paucity of data on the burden of in-stent restenosis (ISR) in the United States as well as on its presentation and appropriate treatment strategies. OBJECTIVES This study aims to provide an analysis of the temporal trends, clinical presentation, treatment strategies, and in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) for ISR in the United States. METHODS This study is a retrospective analysis of data collected in the Diagnostic Catheterization and Percutaneous Coronary Intervention (CathPCI) registry of the National Cardiovascular Data Registry (NCDR) between 2009 and 2017. Of the total patients undergoing PCI, we identified those undergoing PCI for ISR lesions. For comparison of in-hospital outcomes, propensity-score matching was employed. RESULTS Among the 5,100,394 patients undergoing PCI, 10.6% of patients underwent PCI for ISR lesions. Patients with bare-metal stent ISR declined from 2.6% in 2009 Q3 to 0.9% in 2017 Q2 (p < 0.001), and drug-eluting stent ISR rose from 5.4% in 2009 Q3 to 6.3% in 2017 Q2 (p < 0.001). Patients with ISR PCI were less likely to present with non-ST-segment elevation myocardial infarction (MI) (18.7% vs. 22.5%; p < 0.001) or ST-segment elevation MI (8.5% vs. 15.7%; p < 0.001). In the propensity-matched population of patients, there were no significant differences between patients with ISR and non-ISR PCI for in-hospital complications and hospital length of stay. CONCLUSIONS ISR represents approximately 10% of all PCI and is treated most commonly with another stent. Approximately 25% of patients present with acute MI. In-hospital outcomes of patients with ISR PCI are comparable with those undergoing non-ISR PCI.
Expert Takes3 quotes
1/3
“In low-risk lesions, we're still not seeing much restenosis. But if you get into metal jackets, and CTOs, and long lesions, we are still seeing in-stent occlusions . . . there's a symmetry to the sort of patients who are having [ISR] events.”
Issam D. Moussa, Interventional cardiologist, Carle Heart & Vascular InstituteCarle Heart & Vascular Instituteauto_pipelineView source